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5. The Lymphatics of the Lower Extremity
FIG. 610 - The superficial lymph glands and lymphatic vessels of the lower extremity. The Lymph Glands of the Lower Extremity—The lymph glands of the lower extremity consist of the anterior tibial gland and the popliteal and inguinal glands. The anterior tibial gland (lymphoglandula tibialis anterior) is small and inconstant. It lies on the interosseous membrane in relation to the upper part of the anterior tibial vessels, and constitutes a substation in the course of the anterior tibial lymphatic trunks. The popliteal glands (lymphoglandulæ popliteæ) (Fig. 609), small in size and some six or seven in number, are imbedded in the fat contained in the popliteal fossa. One lies immediately beneath the popliteal fascia, near the terminal part of the small saphenous vein, and drains the region from which this vein derives its tributaries. Another is placed between the popliteal artery and the posterior surface of the knee-joint; it receives the lymphatic vessels from the knee-joint together with those which accompany the genicular arteries. The others lie at the sides of the popliteal vessels, and receive as efferents the trunks which accompany the anterior and posterior tibial vessels. The efferents of the popliteal glands pass almost entirely alongside the femoral vessels to the deep inguinal glands, but a few may accompany the great saphenous vein, and end in the glands of the superficial subinguinal group. The inguinal glands (lymphoglandulæ inguinales) (Fig. 610), from twelve to twenty in number, are situated at the upper part of the femoral triangle. They may be divided into two groups by a horizontal line at the level of the termination of the great saphenous vein; those lying above this line are termed the superficial inguinal glands, and those below it the subinguinal glands, the latter group consisting of a superficial and a deep set. The Superficial Inguinal Glands form a chain immediately below the inguinal ligament. They receive as afferents lymphatic vessels from the integument of the penis, scrotum, perineum, buttock, and abdominal wall below the level of the umbilicus. The Superficial Subinguinal Glands (lymphoglandulæ subinguinales superficiales) are placed on either side of the upper part of the great saphenous vein; their efferents consist chiefly of the superficial lymphatic vessels of the lower extremity; but they also receive some of the vessels which drain the integument of the penis, scrotum, perineum, and buttock. The Deep Subinguinal Glands (lymphoglandulæ subinguinales profundæ) vary from one to three in number, and are placed under the fascia lata, on the medial side of the femoral vein. When three are present, the lowest is situated just below the junction of the great saphenous and femoral veins, the middle in the femoral canal, and the highest in the lateral part of the femoral ring. The middle one is the most inconstant of the three, but the highest, the gland of Cloquet or Rosenmüller, is also frequently absent. They receive as afferents the deep lymphatic trunks which accompany the femoral vessels, the lymphatics from the glans penis vel clitoridis, and also some of the efferents from the superficial subinguinal glands. The Lymphatic Vessels of the Lower Extremity—The lymphatic vessels of the lower extremity consist of two sets, superficial and deep, and in their distribution correspond closely with the veins. The superficial lymphatic vessels lie in the superficial fascia, and are divisible into two groups: a medial, which follows the course of the great saphenous vein, and a lateral, which accompanies the small saphenous vein. The vessels of the medial group (Fig. 610) are larger and more numerous than those of the lateral group, and commence on the tibial side and dorsum of the foot; they ascend both in front of and behind the medial malleolus, run up the leg with the great saphenous vein, pass with it behind the medial condyle of the femur, and accompany it to the groin, where they end in the subinguinal group of superficial glands. The vessels of the lateral group arise from the fibular side of the foot; some ascend in front of the leg, and, just below the knee, cross the tibia to join the lymphatics on the medial side of the thigh; others pass behind the lateral malleolus, and, accompanying the small saphenous vein, enter the popliteal glands. The deep lymphatic vessels are few in number, and accompany the deep bloodvessels. In the leg, they consist of three sets, the anterior tibial, posterior tibial, and peroneal, which accompany the corresponding bloodvessels, two or three with each artery; they enter the popliteal lymph glands. The deep lymphatic vessels of the gluteal and ischial regions follow the course of the corresponding bloodvessels. Those accompanying the superior gluteal vessels end in a gland which lies on the intrapelvic portion of the superior gluteal artery near the upper border of the greater sciatic foramen. Those following the inferior gluteal vessels traverse one or two small glands which lie below the Piriformis muscle, and end in the hypogastric glands.
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